Provided by:
The Medical Practice EMR Software Buyer’s Guide
A Practical Guide for Physicians and Medical Practice Office Managers
Valley Forge Corporate Center 2700 Van Buren Avenue
Eagleville, PA 19403 www.sticomputer.com
800-487-9135
Ambulatory EHR ChartMaker Clinical 3.7 + Cardiovascular Medicine + Child Health 2011 ®Eliminate all the Paper
Often, practices will employ someone
whose sole responsibility is finding and re-filing
the charts that are used during the day. An
EMR completely eliminates the need for this
function and immediately reduces costs. This
will eliminate the chance of a HIPAA violation,
when a paper chart could be accidentally left in
a public place.
An EMR can drastically decrease the
amount of time it takes to document chart
notes and can increase the quality of the
content in some cases. If you dictate your
notes using the ChartMaker voice recognition
software, you can save thousands of dollars
each year by eliminating the need to pay a
transcription service.
Another benefit of eliminating the paper
is reducing the costs associated with it.
On average, during the life of each chart
the practice spends $15/chart on paper,
stickers, binders etc.
The cost of these items individually
does not seem like very much, but the
average physician maintains over 3,000
charts. So, the cost is about $45,000
over the life of your practice.
Due to legal requirements, offices
keep charts for seven years after
dis-charging patients. If your office is paying
for off-site storage for paper charts, it is
a better reason to acquire an EMR.
With all of the financial incentives available to you today,
you don’t need to buy a cheap EMR.
Dear Healthcare Professional,Like most medical practices, I’m sure you’ve heard a
bout the generous financial incentives from Medicare ($44,000/ph
ysician) and Medicaid ($64,000/physician) available to physic
ians using Electronic Medical Records (EMR) with e-prescribing
.
I know many physicians had doubts on whether these incentive
s would actually be paid. The good news is that some STI EMR customers have recently received their first inc
entive check from both Medicare ($18,000/physician) and Medicaid ($21,250/ph
ysician). However, time is running out on these incentives. For example, 2012 is t
he last year that you can receive $18,000/ physician from the Medicare Program by demonstra
ting Meaningful Use for only a three month period. See inside for more details on these programs
. With all of the financial incentives available to you to
day, you don’t need to buy a cheap EMR. In most instances, the incentives will more than c
over the cost of a new STI EMR system. It’s critical to purchase an EMR from a vendor with S
taying Power within the industry. Your practice becomes dependent upon the vendor providing you w
ith support and software updates to keep your EMR up-to-date with the latest CMS req
uirements. Without updates the software is useless.
STI sold our first physician practice in 1979 and that practic
e is still using our software today. In 2007, when STI first received EMR certification, t
here were about 55 certified EMRs available for the ambulatory physician marketplace. Onc
e the word got out that physicians were going to receive large financial incentives to use an EMR
, the marketplace was flooded with new companies offering EMR software, many with lit
tle or no previous medical practice experi-ence. At last count, there were over 700 certified EMR pr
oducts available. How many of these products do you think will be around in five years?
George Santayana’s famous quote of “those who cannot r
emember the past are condemned to repeat it” is more relevant than ever. We saw a similar c
ycle during the 1990’s when ph ysi-cians were adopting electronic billing systems. Hundr
eds of new vendors entered the market and many were gone by Y2K and HIPAA.
Don’t miss these generous financial incentives. At this poin
t, there is no time to waste. You can install a quality EMR from STI and the incentive
s will more than pay for the software. Why risk making a mistake with an unknown vendor? Call today at 800-487-9135, e
xtension 1188, and we will visit your practice to show you ChartMaker
. Best Regards,
Joe Cerra
STI Computer Services - 800-487-9135 x 1188
P.S. We would like to show you why using the ChartMaker M
edical Suite will help increase
efficiencies and revenue.
ChartMaker Medical Suite v 3.7 by STI Computer Services, Inc is 2011/2012 compliant and has been certi-fied by the Certification Commission for Health Information Technology (CCHIT®), an ONC-ATCB, in accordance with the applicable certification criteria for Eligible Providers adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. January 5, 2011 - CC-1112-865040-1 Quality Measures Certified: NQF 0421, NQF 0013, NQF 0028, NQF 0041, NQF 0024, NQF 0038, NQF 0031, NQF 0043 and NQF 0068. • Self Attested Additional Software Used in Testing: cid:[email protected].
Computerized Practice Management
Buyers’ Guide
STI offers this guide as a service to help you make an informed decision when purchasing your Practice Management (PMS) or Electronic Medical Record (EMR) System. We believe that the more you know about the choices available to you, the more likely you will be to select the ChartMaker® Medical Suite for your practice.
Although there is a great deal of variation among the different types of software out there today, there are really only two main components of modern medical office software systems: Practice Management Systems (PMS) and Electronic Medical/Health Records (EMR). Both components of an up-to-date medical software solution should address three very simple goals:
1. Increased Efficiency 2. Increased Productivity 3. Decreased Cost
Many practices put too much emphasis on the cost of the system as the sole buying criteria. A medical system is a complex combination of computer equipment, software, training, software updates, telephone support, and hardware maintenance. The following sections will illustrate that cost is just the tip of the iceberg. However, when you do compare costs, compare all of the costs, not just the initial purchase price.
Common Sense vs. Nonsense
“It is unwise to pay too much, but it’s worse to pay too little. When you pay too much, you lose a little money — that is all. When you pay too little, you sometimes lose everything, because the thing you bought was incapable of doing the thing it was bought to do. The common law of business balance prohibits paying a little and getting a lot — it can’t be done.
If you deal with the lowest bidder, it is well to add something for the risk you run, and if you do that you will have enough to pay for something better.” John Ruskin (1819 - 1900)
Increased Efficiency
One major goal of office automation is to reduce the tedious, time-consuming work that is below the optimum work level of your staff. For instance, time spent by office personnel looking for a lost file is time taken away from patient care.
The computer should help you and your staff work at your highest, most creative level. In every industry there remain tasks that are nothing more than time consuming tedium. And sadly, this means that there are people that are paid to punch in day in and day out to complete these tedious tasks. The modern medical practice is no different. But as advances are made in medical software technology, these tasks are slowly but surely being phased out. An up-to-date software system can reduce or eliminate tasks like calling insurance companies to check eligibility or manually finding and re-filing paper charts.
Increased Productivity
The ability to do more work in less time is a primary goal of office automation. A corollary to that, and in some ways a more important one than productivity, is the goal of elevating the level of work of your medical office staff.
Everyone divides their workday between work of different levels. For instance, some part of your day is devoted to high level work, such as decision-making, analysis, patient interaction, development of new resources, etc. Conversely, some part of your day is low-level work,
such as time wasted looking for lost charts or missing information, doing repetitive tasks, clearing up mistakes, etc. Finally, some work lies at any one of various middle levels.
The objective of improved work in office automation is to have the computer reduce the amount of low-level work each employee must perform in a day. It is important to recognize that this theory applies to the receptionist or billing secretary as well as to the physicians and office manager. Your employees will work better and with greater work satisfaction when they spend the majority of their work hours at their highest level of work. And, of course, the practice benefits because overall better, more creative work is done.
Without these monotonous tasks, staff members will be able to devote their time and creative energies towards much more productive goals. Software solutions can help enhance these goals too. Office staff members will perhaps be able spend their time chasing down unpaid debts or running detailed financial reports, thus gaining more control over office billing practices. Similarly, with up-to-date software, doctors will be able to create more comprehensive chart content in less time than it takes to handwrite, type or dictate a note.
Decrease Cost
Finally, an up-to-date medical software system should help decrease the cost of running your practice. Whether it is completely eliminating transcription costs, or decreasing something as simple as money spent printing encounter forms, a current software system should reduce the amount of money needed to run your practice.
Two Components to an Up-to-Date Medical
Practice Software System
When you consider computerizing your medical practice there are two equally important components that you need to consider. There is a clinical side and a business side to your practice.
You need both to run an efficient medical practice. Each piece is equally important if you want to run a profitable medical practice. Obviously you became a physician to practice medicine not to run a business, but without revenue from your medical practice, you can’t continue in private practice. So when you investigate medical software you need to carefully evaluate both aspects. Since the clinical side is usually of more interest to a physician, naturally more attention may be paid to that aspect. However, you need to have your office staff involved to investigate the billing function as well.
A good analogy is the SAT score. If you want to go to a good college you need to have a high SAT score. Traditionally the SAT score was made up of two parts – math and verbal. If you had a high score in math, but a low score in the verbal side, most likely you would not get into the college of your choice. The colleges are looking for students with the highest combined score.
4
When you select a practice software system, you should look for the vendor with the highest combined score in business (billing applications) and clinical (EMR) applications. Don’t make the mistake of concentrating your effort on only one side of the equation, or it’s very possible that you will be investigating software again in the future.
When you investigate practice software, many vendors may excel on the EMR side or the billing side during a demonstration. However, the very nature of the software industry is that recently designed software is typically not as robust as more mature software. Software gets better as more people use it and request enhancements to make it better. Because the EMR component is newer, some practices that have purchased very good EMR software from newer, primarily EMR vendors complain of poor billing components. Some practices have had to replace the software because the billing component was not adequate. STI first introduced our billing software in 1979 and our EMR software in 1995 so we have had the time to properly develop both components.
Benefits Of An Up-to-Date Practice
Management Software
Practice Management Software is the financial component of medical software systems. Practice Management contains the nuts and bolts of the business side of any medical practice. The functions of Practice Management software can vary by brand of software, but a complete program that addresses all of your practice requirements should have most if not all of the following functions.
Electronic Claims Submission
Electronic Claims Submission is vitally important in accomplishing the three goals listed above. If you are not already submitting your claims electronically, you could be losing a lot of money without realizing it. The Center for Medicare and Medicaid Services (CMS) reports that claims submitted electronically experience 21% fewer rejections than those submitted on paper.(1)
Five Reasons to Bill Electronically
1. Less likely to be rejected2. Notification of accepted (clean) and rejected claims 3. Faster payment
4. Better tracking of claims
5. Automatic posting and checking contracted fees
Furthermore, if you submit your claims electronically, you will typically be notified within 24-48 hours if a claim has been accepted or rejected. That way, if there is a problem, it can often be addressed within the same day so little time is lost between submission and payment. Also, with electronic submission, you will get paid almost 2 weeks faster. By law, Medicare must pay claims submitted electronically within 14 days, whereas the average pay period for a paper claim is 26 days. (1) And let’s not forget the most basic of expenses: labor and postage. With paper claims, you not only have to pay for the paper and ink needed to print the claim, you also have to pay for the stamps and envelopes to get them to the insurance company and the time to sort and stuff envelopes. It may not seem like a lot, but each paper claim costs $1.00- $1.50 to send. (2)
Electronic Transmission of Insurance
“The Health Care Financing Administration now called the Center for Medicare and Medicaid Services (CMS) has reported that it rejects 26% of the claims it receives. While that number is astonishing, more astonishing is the fact that 40% of those rejected claims are never resubmitted. These rejections and lost claims confirm that there are significant billing problems in many provider organizations. Using Medicare’s statistics, the lost revenue per physician is about 10%. On a per physician basis, this ranges from approximately $25,000 to over $50,000 per year.” (1)
Electronic billing provides practice benefits to avoid the type of results shown in the above CMS study.
First, electronically submitted claims are not manually keypunched or reviewed and therefore less likely to be rejected. Studies show that practices that bill electronically experience 21% fewer rejections(2). Second, typically within 24-48 hours, you will be electronically notified that the submitted claims have been accepted or rejected. If rejected, they can be quickly corrected and resubmitted the same day. Third, electronically submitted claims are typically paid faster. “By law, Medicare must pay an electronic claim in 14 days. The same paper claim wouldn’t be paid until day 26.” (2)
Fourth, electronically submitted claims can be automatically tracked with the proper software. If a claim is not paid within the agreed time frame, a report can be generated, the carrier contacted and the charge reviewed before automatically resubmitting the claim.
Fifth, after you are paid, your contracted fees can be checked to ensure that you are being paid correctly, and then the computer will automatically bill your secondary carrier or patient. In some cases, Medicare payments can also be posted automatically.
ANSI 5010 Progress
Between January 1st and March 31st 2012, the Centers for Medicare and Medicaid Services (CMS) as well as various insurance companies will require you to send electronic claims and receive your payment remittance files in the ANSI 5010 format instead of the current ANSI 4010 format. STI has added support for ANSI 5010. Most of the changes related to ANSI 5010 happen seamlessly, behind the scenes within the ChartMaker Medical Suite. Here are a few important issues that we would like to share with you.
1. P.O. Boxes are no longer accepted for the billing provider addresses with this new format. The billing address, whether you bill by Practice or Provider, cannot contain a P.O. Box. There are no changes to your enrollment sign ups, or where the checks are sent.
2. The full nine-digit zip code is required for billing provider and service facility addresses. The nine-digit zip code should be entered for all practices, providers and facilities.
0 100 200 300 400 500 600
Av
er
age S
cor
e
Critical Reading Math
Think SAT Score
You want the Highest Combined Score
Business (PMS)
Clinical (EMR)
You need Both Look at Both & Involve Medical and Office Staff
In-House or Outsource Billing?
A successful billing process starts with the right practice management and electronic billing software. Once you’ve chosen your computer technology, the next step is to decide whether to assign the billing function to your own office staff or outsource it to a professional medical billing service. The billing process relies on getting the correct patient and insurance information into the system. Errors in data entry result in rejections, and it’s possible that a claim can be electronically submitted but immediately denied without ever entering the payer’s system for processing. Often, staff in the physician’s office forget or don’t have time to retrieve the next-day reports that will tell you if your claims were accepted. A rejection on this vital report means that your claim was not in fact submitted. If your staff doesn’t catch the error in time, the claim may be rejected for timely filing with no appeal possible.
A professional billing service can insure that charges entered by you or your office staff are done correctly and completely, or even enter the charges for you. They will submit your claims, retrieve the next-day reports, and resubmit any necessary corrections. They will record payments and follow up on denials, rejections, and low payments.
Skilled staff at a billing service can review your aging reports for slow pays, uncover unpaid claims that have been purged by the insurance companies, and send bills to secondary payers. Patient bills can be submitted for you, and if you choose, your patients can call the billing service with questions instead of interrupting your busy staff.
The advantage of using an outside billing service is that you reduce internal labor costs and a professional billing service most likely will have more experience dealing with the insurance carriers than your own staff since this is all that they do. That frees your staff to provide better patient service and not sit on the phone talking to insurance carriers.
Since billing services only get paid a percentage of your collections, they need to work your accounts to get paid. For example if a billing service receives 7% of collections, this means for every dollar that they collect, you receive $0.93 and they receive $0.07. To evaluate a billing service you need to determine your internal cost of collections and compare that to the cost to outsource billing plus any additional collections that an experienced billing service can provide. If they can collect an additional $10,000/month you receive an additional $9,300 and your staff is available to do more important work on patient care.
STI has independent billing services companies that have been trained to work with the ChartMaker software. These companies can provide you an option of either a based or client-server version of ChartMaker. With a cloud-based model, your data resides at the billing service location and they are responsible for software, back-up and server costs. With a client-server version the ChartMaker software is installed in your location and you control the billing information and the billing service comes into your system. The combination of the ChartMaker PMS and EMR system with a professional billing service to verify the accuracy of billing information and to follow-up on claims can provide any practice an advantage. With the ChartMaker EMR a physician can enter charge and diagnostic information directly from the patient chart. That information can be accessed and processed by a professional billing service for processing.
ChartMaker software, in the hands of a trained billing service, may save you time and improve your cash flow. A professional billing service becomes your back office, providing knowledgeable employees who are focused on getting you paid. You may realize lower costs, reduced errors, and increased revenues when you use one of our billing services.
With ChartMaker you have a choice of either doing your own in-house billing, or working with one of our independent billing service companies to process your claims. It’s up to you.
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Financial Reporting Functions
Financial reporting functions work hand in hand with your offices’ ability to bill electronically. What good is it that you can find out about your claim status within 24 hours if you are not able to view that information in a report? An up-to-date software program will give you the ability to run reports to get a full picture of what is going on with the money in your practice.
According to the same CMS report mentioned above, 26% of all claims are initially rejected. As astonishing as that number is, even more astonishing is that 40% of those rejected claims are never resubmitted.(1) This results in an average of about 10% income loss for the physician. Why do you think anyone would let rejected claims go without resubmitting them?
Most rejected claims are not resubmitted because they simply go unnoticed. With proper reporting functions, this should never again be the case.
Would a Computer Help You Provide Better Health
Care?
Primary care physicians who use computers to tickle their memories are twice as likely as other doctors to administer flu vaccine to high-risk patients, a new study suggests. The three-year study involves patients who were over 65 or had chronic lung disease, asthma, diabetes mellitus, congestive heart failure, or severe renal or hepatic failure. Patients whose doctors received computerized reminders had a 10 - 30% lower rate of hospitalization, ER visits and tests for respiratory ailments during the winter.
Medical Economics May 10, 1993 Similarly, proper reporting functions should allow you not only to realize when you have not been paid for a claim, but also when you have not been paid enough for a claim. Sometimes offices will be paid a few dollars less than their contracted amount. Again, it does not seem like you are losing that much, a couple dollars here and there. But if you are getting underpaid a few dollars on 20% of the 500 claims you send each month, this can translate to several hundred dollars a month! In a year’s time, you will have effectively given thousands of dollars back to the insurance companies for work that has been done by you. Again, this problem is easily addressed with the proper reporting functions in a Practice Management system. And reports do not only have to address insurance companies, (consider how much more effective it would be to renegotiate contracts with reports like these in your arsenal!).
Reports can also discern which provider is bringing in the most money at each location, or which procedure is the most lucrative and which ones are not worth doing. The possibilities are limitless.
CMS reports that the average physician doesn’t
collect between $25,000 and $50,000 per year due
to poor billing procedures.
Enhanced Billing Features
If you are using an out of date system, perhaps the most exciting new features will lay in wait for you within the realm of billing functionality. The latest systems are much more robust and easier to use than their older counterparts.
For example, in the ChartMaker’s® Practice Manager module, you have the ability to “scrub” the claims before they are sent out. Whether on a claim by claim basis or on a batch at the end of the day, you can run a test that will generate a report detailing which claims will be denied and why. From there you can go back and fix the problems listed and with one click send out all of your claims with confidence that if the claims are rejected, it shouldn’t be due to a billing error.
Another enhanced billing feature is automatic payment posting. Most offices employ someone to look over insurance EOMB’s, to manually match the payments to the procedures and then enter this information into the computer on a case by case basis. This is a time consuming and often inaccurate process that can result in more lost revenue to the practice.
Electronically submitted claims can receive electronic remittance advice from carriers to automate and streamline the EOMB posting process to reduce labor cost, save time and reduce errors. An up-to-date system can automatically post payments once they receive the electronic remittance advice.
The Paper Chase
The system you choose should be able to bill commercial carriers as well as Medicare. If your current practice computer is only electronically billing Medicare claims you may be losing revenue as well. Electronic billing to commercial insurance companies is as important as electronically billing Medicare since the 40% estimate of not rebilling rejected claims probably applies to commercial claims as well.
As importantly, many practices face an additional labor cost in tracking hardcopy commercial claims. With hardcopy claims there is no way of knowing if the commercial carrier received your claim or its status without a telephone call for follow-up. The billing staff in most practices complain about the delay in payment from commercial carriers and the amount of time spent on insurance follow-up and requests from carriers for resubmittal of hardcopy claims.
It is no wonder that many busy practices don’t collect 40% of rejected claims, with the continuing cycle of mailing hardcopy claims, waiting for payment, telephone follow-up, requests for resubmittal of hardcopy claims, waiting again, another telephone follow-up, etc.
“If you submit claims electronically you have an electronic audit trail that shows when a payer received every claim you sent out.” (3) With the appropriate software, you will receive a confirmation and status typically within 24 to 48 hours. If the claim was rejected it can be corrected immediately and resubmitted the same day. Accepted claims should not require a follow-up call and should be paid quickly.
If your practice is not currently electronically billing every possible insurance carrier, your costs can be far greater than the cost to purchase a new Practice Management System.
The above CMS example claims that many providers are losing between $25,000 and $50,000 per year. This is in addition to a New Jersey Medicine article showing a fixed-cost of about $300 per month as well as lost interest of between $100 and $300 per month for hardcopy billing. (4)
Patient Recall
Many offices already utilize a system of reminding their patients when its time to return for an important test or procedure. An up-to-date practice management system can both enhance and streamline these systems. With technologies like mail merge and automated phone reminder systems, computers can effectively remind patients that its time for them to call to schedule an appointment. And if just two more patients per week schedule an appointment, for some, the revenue generated from those appointments can make a substantial difference in the monthly income.
Eligibility Checking
Oftentimes, even the most responsible patients can have a lapse in insurance coverage without realizing it. And usually, this means that their doctor will not get paid for a very long time, if at all. Most offices will call to check on the insurance eligibility of their patients the day before they are seen. No one likes to sit on the phone with insurance companies, including medical office staff. This process is often time consuming and incredibly tedious.
Lately, insurance companies have utilized the internet to speed up this process, but only slightly. Staff members are still required to enter every digit of each patient’s group number, ID number, doctor’s NPI number etc. As a result, this task can very frequently go overlooked. And that can spell trouble very quickly for an office’s income. An up-to-date Practice Management system can gather all of the necessary numbers and data, transmit them to the insurance company’s website and respond with a list of eligible and ineligible patients. In some cases, it can even retrieve information about referrals and authorizations.
THE BEST COMPUTER SYSTEM ADDRESSES THESE
TYPICAL PRACTICE CONCERNS
Too much time spent pulling and replacing patient charts Lost time searching for patient information
Payment delays and typing redundant information Incorrect patient charges, or lost charges Not sure if all charges have been billed
Complexity of insurance and government regulations Lost patient billing information, or patient records Failure to consistently bill secondary insurance Fear of patient abandonment charges
No time for collections resulting in high bad debt balances Office turnover, increasing office administration costs, and poor employee morale from long hours
Feel out-of-control on the business side of the practice Each provider not properly compensated
No centralized control — one place to find all information
Electronic Medical Records
Electronic health/medical records are the latest buzz in the medical software world. (NOTE: in this guide we will use the terms EMR and EHR interchangeably.) And it seems that even more information is available on all of the varied and different features available to doctors. But, in choosing an EMR, the same three goals listed above apply. An EMR must be able to increase efficiency, increase productivity and decrease the overall cost of running your practice. If it is unable to meet these three goals, it does not matter how many bells and whistles it comes with, it won’t be a practical tool in managing your medical practice. There are features and benefits to look for, though, when researching EMR software.
Elimination of Paper
Many people underestimate the benefit of ridding their office of the constant paper chase. Often, practices will employ someone whose sole responsibility is finding and re-filing the charts that are used during the day. An EMR completely eliminates the need for this function and immediately reduces costs. This will eliminate the chance of a HIPPA violation, in which a paper chart could be accidentally left in a public place. Plus, no more lost charts. Even the most fastidious of re-filers has been known to misplace a chart from time to time. And every office can relate to the scenario of having a patient sitting in the waiting room with his or her chart nowhere to be found. With an EMR, you should not need to deal with a missing chart again.
An EMR can drastically decrease the amount of time it takes to document chart notes and can increase the quality of the content in some cases. Even if you continue to dictate your notes, using the latest voice recognition software, you will be saving hundreds or even thousands of dollars each year by eliminating the need to pay a transcription service.
If lack of time is the problem, usually the first thing to go is the documentation of normal findings. In most cases, the deletion of normal findings is the main contributing factor to under-coding. Although most doctors will evaluate patients and determine these normal findings, they only have time to document the problems that the patient was being seen for, thus drastically reducing the evaluation and management content in their notes.
In 2007 when STI first received EMR certification, there were about 55 certified EMRs available for the
physician ambulatory marketplace. Once the word got out that physicians were receiving large financial
incentives to use an EMR, the marketplace was flooded with new software companies offering EMR
software, many with little or no previous medical practice experience. At last count there were over 700
certified EMR products available.
How many of these products do you think will be around in five years?
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Pros and Cons of Integrating vs.
Interfacing the EMR and PMS
The Interface (Bridge) Dilemma
In today’s medical software marketplace most medical practices want a completely integrated Practice Management System and Electronic Medical Record software from one vendor. However occasionally a practice would like to integrate (called an electronic bridge) two distinct software products from two separate vendors for their practice. Although in some cases a practice has no other option then to bridge two products, it is typically less expensive if you can avoid this project. Before undertaking such an effort it is important to understand the complexities in creating and maintaining an electronic bridge.
Bridge Between a new EMR and Your Old
Billing System
Some vendors suggest that you interface (bridge) their new EMR with your old practice management software. The argument they present is that because their EMR software is HL7 compliant and that your billing software is also HL7 compliant, that both products can be easily interfaced. Nothing can be further from the truth. The HL7 standard is a compatibility index. This means that both products are capable of being interfaced but it does not mean that the interface will take effect automatically. A good medical analogy is a blood transfusion. If one patient has A+ blood and a second patient is also A+ they may be compatible for a blood transfusion. It does not mean that the transfusion happens automatically, and the blood automatically flows from one patient to another. Someone needs to provide the technology, knowledge, and labor for a successful transfusion.
Integrated or Interfaced?
When upgrading your office software system, it is easier to purchase an integrated system (one with both a PMS and EMR from the same vendor) rather than interface a PMS and EMR from two different vendors.
Interfaces are expensive and add undue stress to maintaining a properly functioning system. An interface requires the continuous cooperation from both companies involved. If one company chooses to upgrade their product, it will be your responsibility to get (and probably pay for) the upgrade of the interface. If you must interface your products, have them sharing only critical information.
STI has experience in interfacing the ChartMaker Medical Suite with other software products and vendors. We’ve interfaced with medical laboratory companies, medical device manufacturer’s, other practice management and EMR vendors, hospitals and specific software vendors that provide unique services that STI feels can be better supported by another vendors.
The fact of the matter is that a product interface (also called a bridge) has several issues that must be considered:
• Interfaces requires the cooperation of both vendors to be successful
• Interfaces always requires more programming effort than was originally estimated
• Interfaces are expensive
• Most importantly, interfaces are not a “one-time programming function” but must be maintained over the life of both products. Whenever one product creates a new update or release, often times that will create a programming requirement for the interface and it must be communicated and reprogrammed or the interface could become “broken”. Most programmers will tell you that the rule of thumb is that it costs three times as much to maintain a program than to create it. With interfaces this cost could even be higher since we are dealing with two companies not just one.
• Interfaces of EMR and PMS systems are even more complicated because often what is desired is not just a patient demographics interface, but an interface of patients, referral sources, charges, and appointments which are basically every major file within the software system.
Conclusion: Integrate, Don’t Interface
After decades of development and negotiation, the shipping industry was ultimately able to agree upon a standardized cargo container. The healthcare industry is going through a similar phase that may take just as long involving XML, HL7 and CORBA initiatives. However, today there are no vendors offering a standardized container to “pre-package” all of their data so that one vendor’s PMS can seamlessly share data with another vendor’s EMR. Although the vendors may publish the specifications, still, a significant and ongoing custom programming effort is required to interface these critical
applications. Relying on a fragile, custom interface only complicates the daily usage, reliability, and performance of the two most important computer applications in a physician’s office. To experience the greatest benefit and the least frustration, implement an integrated PMS/EMR. (24)
STI Computer Services, Inc. • 800 487-9135 © Copyright 2012, EVC All rights reserved
Another function of eliminating the paper is reducing the costs associated with it. On average, during the life of each chart the practice spends $15/chart on paper, stickers, binders etc.
The cost of these items individually does not seem like very much, but the average physician maintains over 3,000 charts. So, the cost of maintaining 3000 charts is about $45,000 over the life of your practice. Similarly, charts do not just take up your money; they take up your space. Due to legal requirements, many offices keep charts for seven years after discharging patients (longer for pediatricians). If your office is paying for off-site storage for paper charts, its a better reason to acquire an EMR.
On-Line Chart Access
More importantly, the best part of having charts in an electronic format rather than paper is that you can view an electronic chart from anywhere that you have an Internet connection.
You can refill prescriptions from home or finish up chart notes from the hospital. Gone are the days of staying late in your office finishing up a stack of charts. Now you can go home on time, have dinner and if required access your charts from home when you need to finish a note or make a telephone entry.
Streamlined Chart Entry
Many physicians work after the office is closed to write or dictate their chart notes. An up-to-date EMR system can help eliminate the need to do this. If you are hand writing or dictating your chart notes, an EMR can save you time and money.
Even doctors who are used to dictating their notes will save time. The latest voice recognition software can be integrated into your system and make the transition from paper to computer almost seamless. The only difference you should notice is the amount of money you save each month that would otherwise go to pay a transcriptionist and the elimination of the wait to receive your transcribed notes.
“The trend in practice management systems is toward
integration with clinical information… should you buy both
components from the same vendor? Michael Wiley thinks
so.” (19)
The Five Functions of an EMR
1. Storage — The first function of an EMR is to store patient information within the computer. Each patient visit or interaction, and other related documents or correspondence that relate to that particular patient is stored and accessed by the computer in a manner similar to storage in a medical chart rack.
2. Organization — An EMR organizes basic patient medical information into useful groupings for follow-up and decision-making. For example, the EMR can provide lists for all patient medications or provide lists of patients on certain medications. Telephone messages and recall lists can be maintained. 3. Presentation — The EMR has also been called a structured medical record, because all the information is shown in a standard, structured format to the user. For example, with the ChartMaker® EMR System, the patient’s face sheet is always present on the left of the electronic medical chart with all current problems, medications, allergies, and recalls.
4. Virtual Data Base — Although all of your medical information physically resides in one, secure, computer server in your office, the information in your EMR can be accessed by authorized users at different locations. You have the ability to access patient information remotely. An added benefit is the elimination of lost or misplaced paper charts.
5. Medical Data Input — The fifth function of an EMR is to assist in the input of patient information into the record. ChartMaker® provides you with various methods to add your medical information into the EMR including:
1. Typing directly into the EMR 2. Dictation and transcription 3. Scanning
4. Voice recognition
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E&M Guidelines
Many physicians are concerned that they are coding or under-documenting their patient notes due to a lack of time when seeing patients. Not properly documenting normal findings is often the main contributing factor of under documentation because of time constraints. Usually the work is done but the physician does not document the normal findings.
An up-to-date, EMR can also more accurately help you to determine the proper E&M level by counting the number of items documented in your note as you complete an electronic patient template for an examination. With an EMR, you can quickly document normal findings with the click of a button. And in some systems, like ChartMaker® Clinical, the E&M items can even be tracked in the background of your EMR to make your life easy if you are ever audited.
Electronic Laboratory Results
Electronic Lab submission and retrieval can go a long way toward saving time and increasing efficiency in your office. Many offices still employ a staff member whose responsibility is to retrieve the paper lab results from the fax machine and sort laboratory results alphabetically, find the corresponding charts, match them up and place them on the doctor’s desk to await review.
An efficient turn around time for this process is approximately a day and a half from fax receipt to doctor review. With an EMR the lab results can be sent directly to the doctor and in the case of ChartMaker® EMR, the lab can be linked directly to the patients chart so that it can be filed with one click after review.
HIPAA and Patient Confidentiality
Confidentiality of patient information becomes a bigger concern with the implementation of HIPAA. Besides fraud and abuse provisions, HIPAA also has strict rules on maintaining the confidentiality of patient medical information. Now the release of patient information includes the possibility of large monetary fines and even criminal charges that include the possibility of jail time. The Electronic Medical Record can help your practice to maintain secure guidelines needed to enforce HIPAA’s confidentiality provisions. The EMR should include an integrated patient record password security system to maintain the privacy of your patient records.
Continued on page 11
E&M Guidelines
ChartMaker® includes generic E&M templates including an automatic, numeric tracking system to help you better determine the proper E&M code for each examination that you document. Medical histories, ROS, examination and other medical data are counted by the E&M template to help your medical staff conform with E&M guidelines.
The Evaluation and Management (E&M) documentation requirements are designed to set specific ground rules for both physicians and auditors when medical charts are examined for compliance. For the practical physician it’s important not to have your chart documentation put your practice in jeopardy of being fined.
Besides the need for medical necessity and providing the required patient service, you need a more detailed level of documentation to support a 99213 code than is needed to support a code of 99212. So if you provide the patient the level of service, but do not properly document the service in the patient’s medical chart, you do not qualify for payment. In fact, you may be in jeopardy of a fine for fraud or abuse due to a lack of sufficient documentation. The old adage rings true, “if you didn’t write it down, you didn’t do it.”
An electronic medical record system, like ChartMaker®, can make your job easier. That’s because most of the E&M documentation criteria involves tracking the number of criteria (quantification) performed in an examination to determine a numerical score for each category that determines the level of care supported by your documentation. E&M templates include an automatic, numeric tracking system to help you better determine the proper code for each examination.
Many consultants are recommending that a prudent strategy for their clients includes the implementation of an Electronic Medical Record (EMR) System to reduce their E&M documentation liability.
Some consultants even feel that a non-computerized practice has little chance to conform to the higher-level E&M documentation requirements. (11, 12, 18).
Electronic Prescriptions (eScripts)
There has been increased interest in recent years in the advantages of Electronic Prescribing (eScripts) . The Centers for Medicaid and Medicare Services (CMS) has advocated the universal adoption of this technology for several reasons. First, electronic prescribing can significantly reduce the number of duplicated prescriptions by allowing the prescribing physicians access to an entire list of medications within a pharmacy database.
Second, the utilization of software to aid in the process of eScripts is believed to contribute to the reduction of the number of negative drug-to-drug interactions as well as drug-to-allergy interactions. In the United States last year alone there were over 14 million adverse drug events (ADEs), 2.6 million of those resulted in the death of the patient. Electronic prescribing could drastically reduce this number of events. (23)
Integrated vs. Free Standalone eScript Offers
Although receiving FREE eScript software may initially sound pretty attractive, it is always a good idea to identify the “catch” in the offer. FREE for how long seems to be the most obvious question? The more subtle question is why is it FREE? Once you realize that eScripts software is the first step to the EMR, the answer becomes more apparent.If your FREE software is hosted at the vendor site on their file server (called an ASP model for Application Service Provider - also called cloud-based) as opposed to on-site on your server (called Client-Server) you may have no choice but to purchase the EMR from the ASP vendor or lose the eScript content (your medication data in an electronic format) if you choose another EMR.
So a FREE eScript software plus an expensive EMR may cost you more than a moderately priced EMR with integrated eScripts.
There are several advantages of integration of eScripts into an EMR as opposed to FREE standalone eScript software. In a recent White Paper on e-Prescribing from Covisint (23) the author points out that stand alone eScript technology is disruptive to the physician in that it is not fully integrated with the rest of the practice software causing workflow changes to accommodate duplicate patient data entry, as well as using a second system to view and prescribe.
We would add that the physician is also building valuable patient content (medication history, allergies, etc) into a system that is not integrated with the rest of his patient information when using a standalone eScript system.
In fact this data may reside thousands of miles away on another server and begs the critical question -- How do I retrieve my patient medication and allergy history and import it into my EHR when I am ready to implement this technology and at what cost? The answer may be that “you can’t”, so check before you choose that “FREE” offer. Since ePrescriptions are a required feature of all CCHIT 2008 or later certified EMR, a better solution than a “FREE” standalone ePrescription program is to purchase an entry level EMR program with eScript capabilities that many vendors call “EMR Lite”. Many EMR vendors realize that physicians may not want to purchase all of the capabilities of an EMR initially and provide low-cost versions of their software with limited capabilities that at least can provide you a growth path to a complete EMR when you are ready rather than committing to an ASP
ePrescription product that may require you to walk away from your medication data at a later time.
For example STI provides a low-cost (under $5,000) EMR product called ChartMaker® Entry Point, that can provide your practice not only in-house ePrescription capabilities, but also the ability to receive electronic lab results, maintain a patient face sheet with medication lists, problem lists, and allergies for each of your patients, enter procedures with G-codes, query your medication and problem lists to find patients taking certain medications or with certain problems and medications. More importantly, it includes document management capability to allow you to begin scanning your patient notes into the EMR. So instead of an ePrescription only product that maintains your medication on a distant server that you may need to walk away from in a year or two, you have the foundation of a complete EMR in your office with no data loss if you choose to implement the complete EMR with template, voice or pen-based patient note entry at a later date. A much better option!
For a more thorough discussion on the differences between a cloud-based and client-server system, see the related article on page 18.
Third, electronic prescribing allows pharmacies to become more efficient by demystifying the enigma that is doctor’s handwriting, thereby reducing the number of calls made to doctor’s offices for clarification.
Fourth, Electronic Prescribing allows doctors to receive refill requests directly into their EMR. This allows the doctor to view the patient chart and make accurate medication decisions from anywhere at any time of day.
Besides the patient safety considerations, the widespread adoption of eScripts could offer vast savings to the healthcare industry. “Savings could vary between $27 billion (CITL 2003) and $60 billion annually due to appropriate medication use and diminished ADE’s” (23) eScripts are so important that the CMS provides a financial incentive to send your prescriptions electronically.
Automated Billing Entry
Finally an EMR can automate the billing process even further. In many offices, patients are handed an encounter form or super-bill to carry to the front to check out. If that patient were to just keep walking past the front desk and out the door, many of those same offices would not even realize that a charge was missing. An EMR like ChartMaker® can send charges directly from the clinical side to the Practice Management side using an electronic charge slip in the EMR template.
When the doctor finishes the note diagnosis, procedures and modifiers can be transmitted from the EMR to the billing system with the click of a button. No more lost charges and a reduction in clerical costs as well as possible transcription errors. Since the billing staff no longer has to manually enter each diagnosis/procedure code, they can spend their time doing more productive work.
EMR Certification
Certain standards have been put in place to certify that an EMR software program meets the highest qualifications. One such certification program is called CCHIT (Certification Commission for Healthcare Information Technology). This seal of approval is currently the highest level of certification an EMR program can achieve. CCHIT is designed with the intent to protect doctors from buying software that is not able to complete all of the basic functions necessary to keep appropriate patient records. The government is also utilizing
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these standards to increase the interoperability between Electronic Health Records, so that in the end a patient will have a comprehensive community wide health record, rather than discrete medical records held in separate locations. In theory this should allow physicians to make more informed medical decisions.
Many software vendors do not have CCHIT certification or are not up-to-date with the most recent certification. CCHIT certification becomes more complex and difficult to achieve each year and the year in which the software was certified is included with the CCHIT logo. Software with a later CCHIT certification date is better than software with an earlier date. With a trend moving toward an increase in governmental funding for CCHIT certified EMR software, it would be unwise to purchase an EMR system that does not hold the most recent CCHIT certification.
EMR Incentive Programs
There are many financial incentives to help your practice acquire eScript or Electronic Medical Record software. Let’s discuss current Federal programs designed to assist your acquisition of Electronic Health/Medical Record software.
EMR Physician Recovery Act Incentive
On Feb. 17, 2009, President Obama signed the American Recovery and Reinvestment Act of 2009, a critical measure to stimulate the economy. Among other provisions, the new law provides major opportunities for the Department of Health and Human Services
(DHHS), its partner agencies, and the States to improve the nation’s health care through health information technology (HIT) by promoting the meaningful use of electronic health records (EMR) via incentives. Qualifying physicians can receive up to $44,000 over a five-year period to defray the cost of using an EMR software system in their office based medical practice.
Medicare/Medicaid Providers
You have probably heard about the federal stimulus for practices that implement and “meaningfully use” a certified Electronic Medical Records (EMR) system. Office-based Medicare participating providers who “meaningfully use” a certified EMR, starting in 2011 or 2012, are eligible to receive a financial incentive up to $44,000 per provider. However, what is vital to remember is that you will not qualify for reimbursement, unless you already: purchased your EMR, had your installation and training, and are able to demonstrate that you meet the meaningful use criteria below. For Medicaid participating providers, who have at least 30% of their patients paying through Medicaid (or 20% for pediatricians), you are eligible for up to $64,000 over 6 years.
What is Meaningful Use?
Key to your practice’s participation is meaningfully using an EMR. “Stage 1” meaningful use requirements must be met for the first two-year period that a practice participates in this program. “Stage 2” requirements cover the second period and the government is planning to publish Stage 2 requirements soon. The requirements for the final, fifth year, have yet to be determined.
Stage 1 has 25 objectives. Of these 25, 15 are the Core Set which must be met. The remaining 10 are referred to as the Menu Set. Up to 5 of these Menu Set objectives can be deferred. So, providers may choose which 5, or more, they are going to implement. In cases where meeting an objective is impossible (for example, that specialty doesn’t do that function), exclusions are permitted.
The Stage 1 Core Objectives Are:
• Use Computerized Physician Order Entry
• Implement drug-to-drug and drug-to-allergy interaction checks • E-Prescribing
• Record demographics
• Maintain an up-to-date problem list • Maintain active medication list • Maintain active medication allergy list • Record and chart changes in vital signs • Record smoking status
• Implement one clinical decision support rule • Report Clinical Quality Measures
• Electronically exchange key clinical information
• Provide patients with an electronic copy of their health information • Provide clinical summaries for patients for each office visit • Protect electronic health information created or maintained by
certified EHR
STI employees discussing Meaningful Use implications.
Implementing an Electronical Medical
Record (EMR) In Your Practiice
Implementing an EMR software system can be a challenge for any medical practice. Most physicians that commit to computerizing their practices’ medical records envision themselves using a paperless system and accessing all patient data on computer workstations throughout the office. All patient charts are kept on the computer and the computer prepares all required medical documentation like prescriptions, laboratory orders, patient handouts, and correspondence to other physicians. Everything happens with the click of a computer button and at almost hyper speed. This is the goal but it does not happen overnight. There are a lot of necessary steps required to transition your practice from a paper-based environment to a paperless one. With proper planning and a good implementation plan, the chances of implementation success are vastly improved.
Presented below are a number of keys to success pertain-ing to EMR implementation along with some suggestions for practical implementation:
• ‘Fail to plan = plan to fail’. A planning phase is critical to implementation success. This phase should precede the start of training on the EMR software and should include dis-cussion pertaining to the training schedule, workflow design/ redesign, practice goals/objectives, etc. Physicians, office management, nursing staff, and any other individuals who will be intimately involved with the implementation of the EMR should be present for this part of the process. This not only serves to prepare everyone in the practice for the transition to an EMR based way of medicine, it keeps them feeling involved in the entire process. If your practice contains mul-tiple departments, representatives from each of those depart-ments should be involved in this phase.
• Commitment. The importance of this cannot be overstated. As with most things, one gets out of it what they put into it. Without significant effort directed at planning the train-ing, learning the software, practicing with the software, and assessing/redesigning workflow, the chances of successful implementation are greatly reduced. In addition to partici-pating in the formal EMR training, it’s critical that the office staff practice learning the functionality of the software. Often more learning occurs with hands-on experience.
• Training. Time devoted specifically to formal training is truly one of the most crucial factors when it comes to successful implementation of an EMR. Medical staff and office person-nel should have time throughout their day specifically de-voted to training only, especially in the early stages. Training time should be separate from the office personnel’s typical work duties. Learning robust EMR software programs re-quires dedicated, uninterrupted time for most individuals. • Assess and redesign your workflow. Office workflow will
change with an EMR. The goal of this ‘workflow redesign’ is greater efficiency. Processes which tend to be handled differently with an EMR include messages and prescription
refills, the review and tracking of lab/test results, coding office visits, placing and knowing where patients are in your office, and the daily task of merging paper documents into the ‘electronic chart’ as opposed to the paper chart. The change in workflow will redefine the job responsibilities of some office personnel and lead to greater efficiency within the practice.
• Establish an EMR leader/’super-user’. This individual is typically a physician or an office manager who possesses some level of authority and computer literacy. Implementa-tion failure is imminent if leadership is lacking in the office. The leader should be someone who is intimately involved in the daily workings of the office and someone who can facilitate the forward progress of the EMR. The ‘super-user’ is someone who learns every aspect of the EMR allowing them to serve as an ‘in-house’ go-to person for other staff members who may have questions or who are struggling with learning the software. The ‘super user’ can serve as a very valuable resource to those office staff who may be struggling with the EMR.
• Have a plan for entering existing patient data. At least some portion of the paper chart content needs to be merged into the electronic chart. This is typically performed by a nurse or medical assistant and involves the task of entering patient data such as medications, allergies, diagnoses, past medical history, immunizations, etc. and should be done weeks prior to a ‘go-live’ date with the EMR. This can be a time consuming task initially but serves as a time saver once patients begin to be seen without the paper chart. Document scanning will also play a part in migrating existing patient in-formation into the electronic chart. Typically it’s most efficient to scan only recent data (a couple of months to 2 years) from existing charts.
• Set a ‘Go-live’ date. This is the date that you will begin see-ing patients ussee-ing the electronic chart. This date should be soon after initial formal training has occurred so everything is fresh in the minds of the office staff. It is wise to adjust your patient schedule accordingly. Attempting to go-live on a day with a full patient load is typically not the best way to start off. Even after a period of formal training and practice, it will take some time to develop proficiency and speed with the EMR. Reducing the number of patients you see during the initial ‘go-live’ period or adding additional time to patient visits will create less stress for everyone, prevent discouragement, and provide a greater chance of success.
• Don’t give up! For those practices encountering difficulty with implementing an EMR, a slower, more phased-type ap-proach may be the direction to go. EMR’s, for the most part, consist of various modules. These modules typically include document management, electronic prescribing, templates, voice recognition, messaging and lab interfaces. Modules can be implemented all at once or can be implemented in phases over a longer period of time. If you feel your prac-tice may have undertaken too much at once, take a step back, re-evaluate your practices goals and implementation plan, and take a close look at simply implementing only one or two modules of the EMR. Achieving success with one portion of an EMR will build confidence and allow for an easi-er transition to more complex functions of the software.
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The Menu Set Objectives are:
• Drug-formulary checks
• Incorporate clinical lab test results as structured data • Generate lists of patients by specific conditions
• Send reminders to patients per patient preference for preventive/ follow up care
• Provide patients with timely electronic access to their health information
• Use certified EHR technology to identify patient specific education resources and, if appropriate, provide to patient • Medication reconciliation
• Summary of care record for each transition of care/referrals • Capability to submit electronic data to immunization registries/
systems
• Capability to provide electronic syndromic surveillance data to public health agencies
Meaningful Use Dashboard
Built into the ChartMaker® Medical Suite is a mechanism through which you will assess whether you are meeting the requirements for Meaningful Use. STI’s software helps physicians to qualify to receive up to a $44,000 incentive per physician.
Meaningful Use made easy with ChartMaker’s Dashboard.
Relaxation of Anti Kickback Rules
Thanks to a recent decision by the U.S. Department of Health and Human Services (HHS), physicians will be allowed to accept donations of electronic prescribing software, electronic health records software, and training services from hospitals, medical laboratories, health plans and other entities involved with providing Medicare services under expanded safe harbors to the anti-kickback statute. This, quality experts say, will lead to enhanced quality and patient safety across the health care continuum as interoperability between electronic medical records (EMRs) in physicians’ offices and hospitals increases. The key issues are that he software must be CCHIT certified within 12 months of your acquiring a license, the provider can not restrict the interoperability (ability of the EMR to talk with other EMR or other medical entities) and the donation cannot exceed 85% of the EMR software cost, and you must pay ay least 15% of the cost yourself. STI has hospital and medical laboratory partners that are currently willing to help provide funds for EMR adoption. If you would like to determine if you qualify contact STI at 800-487-9135 extension 1188.
Voice Recognition
Voice recognition is often the easiest function to learn, especially if a physician currently dictates notes. This presents an opportunity for a physician to use this as a starting point when implementing electronic charting while gaining immediate benefits. It is for this reason we
like to describe the voice recognition feature as “The Gateway to the EMR.” Physicians begin using additional modules in the EMR as their comfort level with the software increases opening the door to greater efficiency and quality of patient care.
Help Minimize Malpractice Liability and
Insurance Premiums
An EMR can provide more complete and detailed patient medical chart documentation to help reduce your malpractice liability caused by incomplete or illegible documentation. A June 1996 article in Health Data Management Magazine (15) stated “Physicians who use computer based patient records software are likely have a lower risk of losing a malpractice lawsuit than those who rely on paper records.”
The article continues to say, “By their very nature, computerized patient records prompt physicians to ask pertinent questions that will help them make a diagnosis and rule out other possibilities.” A template process provides this prompting function by including items to review during the patient examination.
The article makes several important points about malpractice litigation, “ In court the doctor has two things going for or against his or her case: the testimony of an expert witness and the medical record ... Anybody who’s been to court and seen a scrawled, illegible handwritten medical record blown up on a big piece of poster board certainly can appreciate the defensibility of accurate, concise computerized medical records.” In a related Medical Economics article, called Why Defensible Malpractice Cases Have To Be Settled (16), the author states, “I’m amazed at the poor documentation I see from physicians with outstanding reputations, and how many doctors won’t take documentation seriously enough to be specific.… “
Lack of recollection is the largest single cause of out-of-court settlements of defensible cases.” With an EMRdetailed medical notes are maintained and chronologically organized for quick review. The author continues to state, “office or hospital notes are so skimpy or illegible as to be of almost no value.” Some insurance companies now offer reduced premiums on malpractice insurance to physicians who use computerized patient records, especially if the system includes the ability to send prescriptions electronically.
Specific Functions of a Up-to-date System
Electronic Medical Records
Electronic Claims Submission
Patient Scheduling
Patient Recall and Follow-up
Eligibility Checking
Chart Summary
ePrescriptions
Referral Letter Preparation
Marketing Trends & Patient Analysis
Mailing Labels for Focused Marketing
Managed Care Analysis and Referrals
Capitation Tracking
RVU Analysis
Auto Posting of the EOMB
On-Line Interface to Local Insurance Plans
On-Line Medical Laboratory Interfaces
Insurance Card Scanning
Internet Access for Claim Checking or Referrals
STI and Interoperability of Electronic
Medical Records
One of the goals of the new Healthcare Initiative Program from the federal government is for ambulatory medical providers to have the ability to share medical information electronically with other medical entities (medical centers, hospitals, Region-al HeRegion-alth Information Organizations, and medicRegion-al laboratories for example) to provide better patient care and to reduce costs. Interoperability refers to this ability of diverse healthcare infor-mation systems to work together. STI is dedicated to this effort and our goal is to help connect the 3,000 medical practices that use STI software products to share information.
The United States is building a point-of-care health informa-tion system similar to the network of electronic banking. As an example, if you can access your money from any ATM in the world, why can’t you access a patient’s medication history in a similar fashion? Through health care information exchange and interoperability, physicians and other medical providers (with a need-to-know) will have access to a longitudinal medical record. “Interoperability is a fundamental requirement for the health care system to derive the societal benefits promised by the adoption of electronic medical records (EMRs)”(25). This interoperability standard is so important that the federal government has made exceptions to the Anti-Kickback rules for EMR donations to physicians from medical centers, health plans and medical laboratories to in some cases help you pay for an EMR. They cannot pay the whole cost of an EMR but in some cases they can pay up to 85% of the software cost of an EMR. Interoperability is so important that any organization that restricts the sharing of information is not eligible to participate in this program. If anyone tells you that you can only use one EMR to access information you may want to refer them to the Federal Register (42CFR Part 411 August 8, 2006). Here are some of the organizations that STI is currently working with to ensure the interoperability of our software.
Regional Health Information Organizations (RHIOs) are key to the US National Health Information Network (NHIN). The Office for the National Coordinator has contracted with the National Alliance for Health Information Technology to lead workgroups of national experts in defining key terms including RHIO and to solicit public comments.
HEALTHeLINK™ Western New York RHIO
STI is one of 10 strategic vendors with the HEALTHeLINK™ Western New York RHIO an unprecedented collaboration among physician, hospital, and insurance organizations to share clinical information in efficient and meaningful ways to im-prove the delivery of care, enhance clinical outcomes, and con-trol healthcare costs throughout the western New York region.
Greater Rochester RHIO
STI is an approved vendor working with the Rochester RHIO and the Monroe County Medical Society to get doctors con-nected to their community. The RHIO connects area doctors, laboratories, area hospitals, ambulance companies, radiology providers, and payers. Rochester RHIO is a secure electronic health information exchange that gives authorized medical
providers access to test results, lab reports, radiology results, medication history, insurance eligibility and more.
HIXNY Albany New York area RHIO
STI is an approved vendor working with HIXNY, a collabora-tion of health plans, hospitals, physician practices and other entities in a 17 county geography comprising the Capital Re-gion and Northern New York. HIXNY has built an interoper-able network to electronically share medical information more efficiently for the benefit of healthcare consumers.
Delaware Health Information Network (DHIN)
STI is one of four certified vendors with this state wide RHIO in Delaware. DHIN is a communication system that is available to healthcare providers throughout Delaware. Through a com-bination of the latest in technology and well-designed security practices, this system makes it possible for physicians, hospi-tals and labs to deliver and access critical health information to ensure better healthcare for patients.AtlantiCare Health System
AtlantiCare is a Southeastern NJ regional integrated delivery network. InfoShare, AtlantiCare’s IT Company, provides information sharing between medical providers and their healthcare consumers through its web-based electronic Health Information Exchange (HIE). The Web enables physicians and other healthcare providers to access their patients’ consolidated clinical information at the hospital, office and home 24 hours a day
